Generality
Fetal hydrops is a serious medical condition, characterized by the accumulation of fluid in the subcutaneous tissues and in the serous cavities of a fetus or a newborn.
There are two subtypes of fetal hydrops: non-immune fetal hydrops and fetal immune hydrops.
The fetal immune hydrops, on the other hand, almost always depends on a maternal-fetal blood incompatibility for the Rh factor.
Possible symptoms of fetal hydrops include: fluid in the serous or subcutaneous tissues (edema), respiratory problems, pallor, ecchymosis, jaundice, anemia and heart failure.
The treatment of fetal hydrops depends on the triggering causes and the ongoing symptoms.
What is fetal hydrops?
Fetal hydrops is a serious medical condition, characterized by the accumulation of fluid in at least two body areas of a fetus or a newborn (newborn) child.
The accumulation of fluid can occur in the subcutaneous tissues - in these situations the doctors talk about edema - or in the serous cavities . Among the serous cavities usually affected by fetal hydrops, are:
- The abdomen . The accumulation of fluid in the abdominal cavity (or peritoneal cavity) is called ascites .
- The pericardium . The accumulation of fluid in the pericardial cavity is known as pericardial effusion .
- The pleura . The accumulation of fluid in the pleural cavity is known as a pleural effusion .
Causes
Based on the triggering causes, doctors have thought of distinguishing fetal hydrops in two subtypes: non-immune fetal hydrops and fetal immune hydrops .
NON-IMMUNE FETAL HYDROPE
Characterizing more than 90% of clinical cases, the non-immune fetal hydrops represents the most common fetal hydrops subtype.
Its presence is the result of an increase in interstitial fluid or lymphatic obstruction.
The causes of fetal non-immune hydrops include:
- Cardiovascular conditions, such as arrhythmias, coronary embolism, arteriovenous shunts, myocarditis, cardiac tumors, tetralogy of Fallot or Ebstein malformation.
- Chromosomal abnormalities, such as Turner syndrome, trisomy 21 or Noonan syndrome.
- Infections of various kinds, such as toxoplasmosis, rubella, chickenpox, syphilis, Lyme disease, AIDS and infectious cytomegalovirus diseases, herpes simplex virus, enterovirus or parvovirus.
- Lung malformations, such as pulmonary hypoplasia.
- Malformations of the urinary tract.
- Episodes of congenital diaphragmatic hernia.
- A serious state of anemia, resulting from thalassemia or an iron deficiency.
IMMUNE FETAL HYDROPE
The fetal immune hydrops occurs due to an incompatibility between the mother's blood group and the blood group of the future unborn child. In fact, when the above situation arises, the mother produces anti-fetal erythrocyte antibodies, which attack the latter giving rise to various complications, including the accumulation of fluid in the subcutaneous tissues and / or in the serous cavities (i.e. 'fetal hydrops).
In most cases, the fetal immune hydrops derives from a maternal-fetal incompatibility for the Rh factor (or Reshus factor).
Symptoms, signs and complications
The symptoms and signs of fetal hydrops vary depending on the severity of the fetal dropsy itself. In other words, the milder forms of fetal hydrops are responsible for a less severe symptomatology than the more severe forms.
SLIGHT FORMS: TYPICAL SYMPTOMS
Generally, milder forms of fetal hydrops induce ascites and pallor.
Readers are reminded that, although in mild form, fetal hydrops is a serious medical condition.
SERIOUS FORMS: TYPICAL SYMPTOMS
As a rule, the most severe forms of fetal hydrops cause:
- Respiratory problems;
- Appearance of skin ecchymoses or purple spots on the skin;
- Heart failure;
- Severe anemia;
- Severe jaundice;
- Edema in various parts of the body.
| Symptoms / signs of fetal hydrops during pregnancy |
| Huge amounts of amniotic fluid |
| Thickened placenta |
| Accumulation of fluid in the pericardial, peritoneal and / or pleural cavities |
| Symptoms / signs of fetal hydrops immediately after delivery |
| Pallor |
| Ascites |
| Respiratory problems |
| Enlarged liver and spleen |
COMPLICATIONS
Fetal hydrops is a highly lethal condition for children who are affected.
In cases of fetal immune hydrops due to a maternal-fetal incompatibility for the Rh factor, the subjects that survive the birth and even the following weeks are at high risk of kernicterus .
Kernicterus is a particular form of encephalopathy, characterized by the accumulation of bilirubin in brain tissue. Not surprisingly, kernicterus is also known as bilirubin encephalopathy.
Diagnosis
Usually, for a correct diagnosis of fetal hydrops, the use of a prenatal morphological ultrasound is fundamental. In the images reported by the latter, they are typical signs of a fetal hydrops:
- The presence of large amounts of amniotic fluid;
- The presence of a large placenta;
- The abnormal presence of fluid around certain organs of the fetus, including the liver, spleen, heart and / or lungs.
WHICH DIAGNOSTIC EXAMINATION ALLOWS YOU TO ESTABLISH SEVERITY?
To understand the gravity of a fetal hydrops, doctors can resort to an amniocentesis or to periodic morphological echographies.
HOW TO ESTABLISH THE FOTAL IDROPE SUBTIP?
To establish the subtype of fetal hydrops present, doctors need to take a maternal blood sample and search for any fetal erythrocyte antibodies in it. The presence of the above antibodies indicates that the fetal hydrops is of the immune subtype; their absence, on the other hand, means that the fetal hydrops is of the non-immune type.
Identifying the subtype of fetal hydrops is essential for planning the most appropriate therapy and hoping for a better (or less unfavorable) prognosis.
Therapy
The treatment of fetal hydrops varies in relation to several factors, including, mainly, the triggering causes and the ongoing symptoms.
TREATMENT IN PRENATAL AGE
In prenatal age, fetal hydrops is treatable only in certain circumstances (eg, presence of anemia at the origin of fetal hydrops).
In these circumstances, the typical treatment consists of a transfusion of intrauterine fetal blood .
When there is a lack of prenatal care options, doctors promote the premature birth of the fetus, as the therapeutic possibilities for newborns are greater and more effective. The premature birth of the fetus can take place by means of particular drugs, which stimulate labor, or by cesarean section.
TREATMENT IN NEONATAL AGE (OR POST-CHRISTMAS)
Fetal hydrops in newborns include:
- The blood transfusion, to clean the latter from the fetal erythrocyte antibodies, passed from the mother to the child, when the first provided blood circulation in the second;
- Removal of the fluid accumulated in the pleural or abdominal cavities by syringe;
- The administration of medicines to check for cardiac problems (heart failure);
- The administration of drugs that stimulate the kidneys to eliminate excess fluid, present in the subcutaneous tissues;
- The use of breathing aids, such as artificial ventilation machines.
Prognosis
Very often, fetal hydrops causes the death of the child either shortly before birth or shortly after birth. The prognosis, therefore, tends to be unfavorable.
Prevention
For several decades now, it is possible to prevent fetal immune hydrops from using a drug called RhoGAM (or immunoglobulin Rho ). Administered only and exclusively to pregnant women with a maternal-fetal incompatibility for the Rh factor, RhoGAM prevents the mother's immune system from producing antibodies to fetal erythrocytes, that is the agents triggering the condition of fetal immune hydrops.
